Complaint Investigation Report

157204130-5-4-2022-24-AS-MHON-CE9MUT-20220509095538

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

This is an official report of an unannounced visit/investigation of a complaint received in our office on

01/20/2022 and conducted by Evaluator Lisa Salazar

COMPLAINT CONTROL NUMBER: 24-AS-20220120152006

Resident's authorized person was not refunded according to the Admission Agreement

On 05/03/2022, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to deliver findings on the above allegation. LPA was greeted by Executive Director and allowed entry into the facility. COVID precautionary measures were taken.

During the investigation, LPA conducted interviews and reviewed records. Interviews with reporting party, and staff reveal a refund was given to the Estate of R1 on 12/29/21. Per the admission agreement, facility should have issued the refund within 15 days of R1's removal of personal belongings from the facility.

Based on the LPA's records review and interviews, the preponderance of evidence standard has been met; therefore, the above allegation is found to be substantiated. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D.

An exit interview was conducted and appeal rights given.